tbuckley/cabot-search huggingface dataset:
Abstract 15051: A Large Mitral Valve Vegetation in a Patient Presented With Low Back Pain and Lower Limb Weakness- A Success Story of a Multidisciplinary Team
Authors: Kazi Bodruddoza, Eshita Majumder
Journal: Circulation (2022)

Case presentation: A 58-year-old gentleman presented to A&amp;E with low back pain for a few days and lower limb weakness for 24 hours. His background history was not medically significant. On examination, GCS 14/15, lower limbs power 2/5, and palpable urinary bladder. DRE revealed poor anal tone. MRI spine showed epidural abscess at L3-L4 &amp; L5-S1 level and urgent decompressive spinal surgery was performed. IV antibiotics were started and the patient was admitted to the general HDU for vasopressor support. Since the operation, he developed cold, pale, swollen right leg, with no palpable peripheral arteries. A CT aortogram showed occlusion of the right popliteal artery. Right popliteal artery exploration with anterior and posterior tibial embolectomy and fasciotomies were done. As the patient was slow to wake up post-surgery, he was transferred to ICU. MRI brain showed no pathology. Transthoracic echocardiogram revealed no vegetation. As clinical suspicion of infective endocarditis was high, transoesophageal echocardiogram and real-time 3D analysis was done which showed a large highly mobile echogenic mass attached to the left atrial surface of the anterior mitral leaflet (A1 and A2) causing moderate MR. Urgent surgical mitral valve repair and removal of a 2 cm vegetation were performed. Both the blood culture and the culture of the vegetation tissue confirmed the growth of Staphylococcus aureus (MSSA). After 8 weeks of hospital stay, the patient was discharged home. Discussion: The objective of this case presentation is to reemphasize that infective endocarditis is not a single organ disease and can present to different specialities. Transthoracic echocardiography has reduced sensitivity in the critical care setting. So, there should be a relatively low threshold for transoesophageal echocardiography. Although the mortality rate of infective endocarditis is relatively high in ICU patients, multidisciplinary team management may result in favourable outcomes.
Abstract 194: The Effect Of Recombinant Erythropoietin On Very Long-term Outcome After Moderate To Severe Traumatic Brain Injury
Authors: Markus B Skrifvars, Nora Luethi, Michael Bailey, Craig French, Alistair Nichol, Tony Trapani, Colin McArthur, Yaseen Arabi, Stepani Bendel, Jamie Cooper, Rinaldo Bellomo
Journal: Circulation (2022)

Objectives: Recombinant erythropoietin (EPO) administered during intensive care is one possible treatment method for patients with traumatic brain injury that may increase short-term survival. Its effect on long-term outcome including functional outcome is unknown. Methods: We conducted a long-term follow up of patients included in the multi-center erythropoietin in traumatic brain injury (TBI) trial (Clinical Trials.gov NCT00987454) conducted between 2010 and 2014. We invited patients treated in all countries except France to participate in a follow-up and evaluated survival and functional outcome with the Glasgow outcome scale extended (GOSE) with categories 5 to 8 defined as good outcome. We categorized TBI severity with the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT-TBI) model and calculated adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: Of 603 patients included in the original trial, 371 were included in the follow-up at a median of six years from injury (interquartile range 3-8 years). Out of 185 patients treated with EPO, 140 (76%) were alive and 110 (60%) had good outcome. The corresponding numbers for the 180 placebo patients were 136 (73%) and 100 (53%) (p=0.57, p=0.27). A multivariable model adjusting for the IMPACT severity provided comparable results the effect of EPO for survival (OR 1.3 95% CI 0.8-2.2, p=0.31)) and good outcome (OR 1.5 95% 0.9-2.4, p=0.09). Conclusions: EPO did not decrease mortality or improve outcome but the limited sample size does not rule out clinically meaningful effects suggesting the need for a larger study.
Abstract 14710: Social Determinants of Sleep Disturbances Among Adults With Multiple Cardiovascular Disease Risk Factors
Authors: Xiaoyue Liu, Yvonne Commodore-Mensah
Journal: Circulation (2022)

Background: Social determinants of health (SDoH) play a critical role in sleep. Patients with multiple cardiovascular disease (CVD) risk factors are vulnerable to poor sleep. Few studies have examined SDoH related to poor sleep in this vulnerable group. Therefore, we focused on adults with all three CVD risk factors - hypertension, diabetes, and obesity- and examined the relationships between SDoH and sleep outcomes. Methods: We analyzed data from the 2013-2018 National Health Interview Survey among adults with hypertension, obesity and diabetes. Sleep outcomes included sleep duration (categorized as &lt;7, 7-9, &gt;9 hours), days having trouble falling asleep, and days having trouble staying asleep (both categorized as no trouble, 1-3, 4-7 days). We used multivariable logistic regression to examine the relationship between SDoH (race, sex, education, income, marital status, employment status, and neighborhood cohesion) and sleep outcomes. Results: The sample included 9,695 adults aged 62 (±12) years. Over half slept either &lt; 7 or &gt; 9 hours, and 44.2% and 51.2% reported having trouble falling and staying asleep, respectively. Black adults were more likely to sleep &lt; 7 hours compared to white adults (OR=1.32, 95% CI: 1.00-1.74). Income &gt; $100,000 was significantly related to having trouble staying asleep (OR=1.87, 1.01-3.46) in comparison to income &lt; $35,000. Compared to adults who lived in neighboordhood with higher social cohesion, those in neighborhoods with lower social cohesion were more likely to sleep &lt; 7 hours (OR=1.57, 1.24-1.99) and have trouble staying asleep (OR=1.36, 1.07-1.74). Unemployed adults were less likely to sleep &gt; 9 hours and experience trouble falling or staying asleep. Conclusions: Race, income, employment status, and neighborhood cohesion were related to sleep among adults with hypertension, diabetes, and obesity. Targeted sleep interventions should be implemented for high-risk patients who experience specific characteristics of SDoH.
Abstract 15417: Dual Ampk Activator/mtor Inhibitor Improves Metabolic Parameters in T2d Mice and Protects Cardiomyocytes Against Ischemic Injury
Authors: Donatas Kraskauskas, Bin Ni, Adolfo G Mauro, Valerie Lau, Varun Kodali, Arun Samidurai, Igor Belka, Laura Corral, Kyle W Chan, Cathy A Swindlehurst, Fadi N Salloum, Anindita Das
Journal: Circulation (2022)

Background: Type 2 diabetes (T2D) is a major metabolic disorder associated with increased morbidity and mortality, predominantly due to heart failure resulting from superimposed ischemic heart disease. Dual AMPK activation/mTOR inhibition (NovoMedix compound, NMX2) has been shown to attenuate adverse cardiac remodeling and fibrosis in a pressure-overload mouse model of heart failure. Given the importance of AMPK signaling in T2D, we investigated the beneficial effects of chronic treatment with NMX2 in T2D mice. Methods &amp; Results: Adult male db/db T2D mice were treated daily with NMX2 (50 mg/kg, p.o.) or equal volume of vehicle (7% DMSO, as control) for 15 weeks. Increase in body weight was significantly attenuated along with reduction in insulin levels with NMX2 treatment as compared to control ( A-B ). NMX2 treatment improved glucose homeostasis (glucose and insulin tolerance tests) and reduced adiposity (fat mass percentage, measured by body composition analysis) ( C-G ). Respiratory exchange ratio (RER) measured by indirect calorimetry analysis (Phenomaster, TSE) was significantly improved in NMX2-treated mice, which indicates increased glucose utilization as compared to control mice ( H &amp; I ). Cardiomyocytes isolated from control and NMX2-treated db/db mice were subjected to simulated ischemia/reoxygenation (SI/RO, 40 minutes SI and 1 hour RO). NMX2 significantly reduced necrosis (trypan blue staining, J ), apoptosis (TUNEL assay, K ) and activation of the NLRP3 inflammasome (apoptosis speck-like protein, ASC aggregation by immunofluorescence staining, L &amp; M ) in cardiomyocytes compared to control. Conclusion: Chronic treatment with NMX2 improves glucose homeostasis and RER and reduces adiposity and body weight in diabetic mice. NMX2 also protects cardiomyocytes from diabetic mice against ischemic injury by reducing sterile inflammation, which supports the development of this treatment modality for T2D and its related cardiac complications.
Abstract 15545: Development and Validation of a Risk Score to Predict Kidney Replacement Therapy in Covid-19 Patients
Authors: Milena S Marcolino, Flávio A Figueiredo, Lucas Emanuel F Ramos, Magda C Pires, Daniela Ponce, Rafael L Carvalho, Luanna S Menezes, Karina Paula M Martins, Maira V Viana Rego Souza e Silva, Guilherme F Nascimento, Talita F Oliveira, Maria Clara P Lima, MARIA APARECIDA C CAMARGOS BICALHO, Fernando Anschau, Polianna D Pereira
Journal: Circulation (2022)

Introduction: Acute kidney injury (AKI) is frequently associated with COVID-19 and the kidney replacement therapy (KRT) requirement is associated with disease severity and increased mortality. This study aimed to develop a prognostic score for predicting the need for KRT in inhospital COVID-19 patients. Methods: This multicentric cohort included 5,212 adult COVID-19 patients were between March/2020 and September/2020. Demographic data, comorbidities and conditions at hospital admission, laboratory exams, the need for mechanical ventilation, and complications (AKI, KRT, death) were collected from the medical records. The accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Risk groups were proposed based on predicted probabilities: non-high (up to 14.9%), high (15.0 - 49.9%), and very high risk (≥ 50.0%). Results: The median age of the model-derivation cohort was 59 (IQR 47-70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalization. The validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. Thirty-two variables were tested and four important predictors of the need for KRT during hospitalization were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation, and diabetes. The need for mechanical ventilation at any time of hospitalization was the variable with the highest weight in the score. The presence of this variable alone increases the risk of needing KRT to high. The MMCD score had excellent discrimination in derivation (AUROC = 0.929; 95% CI 0.918-0.939) and validation (AUROC = 0.927; 95% CI 0.911-0.941) cohorts an good overall performance in both cohorts (Brier score: 0.057 and 0.056, respectively). The score is implemented in a freely available online risk calculator (https://www.mmcdscore.com/). Conclusion: The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalized COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation.
Abstract 15533: The Association Between Life’s Simple 7 and Arterial Stiffness in Black and White Women
Authors: Telisa Spikes, Jordan Pelkmans, Sandra B Dunbar, Priscilla E Igho-Pemu, Herman A Taylor, Puja Mehta, Arshed A Quyyumi
Journal: Circulation (2022)

Background: Black women have a higher prevalence of nonideal cardiovascular health (CVH) related risk factors across most components of the American Heart Association’s Life’s Simple 7 (LS7) than White women. Due to a higher burden of CVH-related risk factors, research suggests that Black women have accelerated and higher arterial stiffness than White women. However, the association between LS7 CVH and arterial stiffness among Black and White women is unknown. Objective: To examine the association between LS7 and arterial stiffness and investigate whether race modifies this association. Methods: We examined 1,640 adult women (n=1165 White, n=475 Black) from the Morehouse-Emory Center for Health Equity and Predictive Health Institute cohorts. Carotid-femoral pulse wave velocity (cfPWV), a marker of arterial stiffness, was assessed by applanation tonometry (SphygmoCor®). LS7 summary score (range 2-13) of 2-4 indicate ‘poor’, 5-9 ‘intermediate’, and 10-13 ‘ideal’ CVH. Cross-sectional analysis between the LS7 CVH 3-level categorical variable, cfPWV, and effect modification by race were examined. Multivariable linear regression models were conducted to examine the association between LS7 CVH and cfPWV, adjusting for model 1:(race, age); model 2:(model 1+ education, income). Results: Mean age 51±10.2 years. Compared to ‘ideal’ CVH, ‘poor’ ( β =1.08 m/s; 95% CI, 0.44, 1.71) and ‘intermediate’ ( β = 0.32 m/s; 95% CI, 0.20, 0.45) CVH groups had higher mean cfPWV in the minimal and fully adjusted models. Interaction of LS7 CVH and race on cfPWV was significant (p=.03) with Black women having higher mean cfPWV for each CVH group compared to White women. In race-stratified models, Black women with ‘poor’ ( β =1.56 m/s; 95% CI, 0.79, 2.32) and ‘intermediate’ ( β =0.46 m/s; 95% CI, 0.23, 0.68) CVH had higher cfPWV after minimal and full adjustment. Conclusions: Better CVH was associated with lower arterial stiffness. Compared to White women, Black women had greater arterial stiffness that was most pronounced for ‘poor’ and ‘intermediate’ CVH. Given that arterial stiffness is a prognostic measure, further study of health behaviors and psychosocial factors that contribute to higher arterial stiffness in Black women is warranted.
Abstract 15505: Cardiac-Specific Jarid2 Deficiency, Results in Improved Survival and Myocardial Function Following Experimental Sepsis
Authors: James N Tsoporis, Sahil Gupta, Amin Ektesabi, Shehla Izhar, Youngsook Lee, Thomas G Parker, Howard Leong-Poi, Claudia dos Santos
Journal: Circulation (2022)

Introduction: Myocardial depression and associated hemodynamic collapse are among the major causes of death in severe sepsis. Management of severe sepsis is largely supportive. Hypothesis: Emerging evidence suggests that the transcriptional repressor Jarid2 may play a regulatory role in sepsis; however, the functional role of Jarid2 in sepsis-induced myocardial dysfunction remains uninvestigated. Methods: Using both in in vivo (murine model of cecum ligation and puncture (CLP) in 12-week-old C57-wild type (WT) and cardiac specific Jarid2(knock-out, KO)) and in vitro (lipopolysaccharide, LPS) treatment of cultured murine cardiac myocytes) approaches we determined whether Jarid2 is a putative novel target for sepsis. Results: In response to CLP for 48hrs, WT displayed &gt;60% mortality, survivors developed bacterial peritonitis, a marked inflammatory response (3-5-fold increases in serum and left ventricular (LV) interleukin (IL)-1beta, IL-6 and tumor necrosis factor (TNF)-alpha), myocardial dysfunction (20-35% decreases in dp/dt and echo-derived % ejection fraction (EF) and % fractional shortening (FS)), and a 40-50% decrease in LV Jarid2mRNA and protein compared to WT-sham. Jarid2KO mice showed resistance to CLP-induced bacterial peritonitis resulting in improved cardiac function (10-15% decrease in %EF and %FS), and survival (&gt;90%) despite an exacerbated (10-15-fold increase in LV) inflammatory response compared to WT mice. In adult cultured cardiac myocytes derived from WT and Jarid2KO mice, treatment with the endotoxin LPS (1 microgram/mL) for 24 hrs, resulted in an 8-10-fold and 20-35-fold increase respectively, in the inflammatory cytokines TNF-alpha, IL-1beta and IL-6. Conclusions: These findings reveal that the loss of Jarid2 enhances bacterial clearance and despite an enhanced inflammatory response, resulted in improved myocardial function and survival following CLP-induced sepsis. As such, Jarid2 may be a novel therapeutic target in the treatment of sepsis-induced myocardial dysfunction.
Abstract 15470: Mathematical Modeling of the Determinants and Consequences of Mitral Regurgitation: Jacobian Sensitivity Analysis of a Lumped Parameter Model of the Cardiovascular System
Authors: Tyler J Smith, Jeesoo Lee, Michael Markl, James D Thomas
Journal: Circulation (2022)

Background: Mitral regurgitation (MR) results in complex changes to hemodynamics, which lumped parameter (LP) models of the cardiovascular (CV) system can model. A previously validated LP model using time varying elastance of the atria and ventricles models pressure, volume, and flow in the four chambers and valves of the heart and arterial and venous compartments. Here we model moderate MR and perform a Jacobian matrix sensitivity analysis to explore impact of CV parameters on MR variables. Methods: Using MATLAB app designer, we made an app to give input parameter and output variable specification for the LP model, displaying pressure, volume, and flow curves and specified output variables at equilibrium. Sensitivity analysis was done with a Jacobian matrix, showing the proportional change (Δ) in output variables ( y i ) to change in each input parameter ( x j ), [(Δy i /y i )/(Δx j /x j )]. We assessed the change in these output variables: LA peak pressure (LAP), Forward Stroke Volume (FSV), and MR Volume (MRVol); in response to changes in these input parameters: LV End Systolic Elastance (LVESE), MR Orifice Area (MROA), and peripheral vascular resistance (PVR) in the setting of moderate MR (MROA=0.3 cm 2 ). Results: Pressure curves for the left atrium and ventricle and aorta with and without moderate MR are shown, with the Jacobian sensitivity matrix in Figure 1. To use the Jacobian matrix, multiply a small proportional change in the input parameter (rows) with the value under the output variable (columns). For example, a 10% increase in MROA will cause a 3.7% increase in LAP, 0.8% fall in FSV, and 8.3% increase in MRVol. Conclusion: This analysis shows how small changes in many parameters impact multiple output variables. MRVol is most sensitive to changes in MROA, while the impact of LVESE (contractility) and PVR (afterload) are appropriately discordant. This model warrants further study to predict instantaneous hemodynamic changes in MR and a host of other entities.
Abstract 14701: Angiographic and Prognostic Difference of Acute Myocardial Infarction Patients With and Without Out of Hospital Cardiac Arrest Stratified by Killip Classification
Authors: Tairo Kurita, Hiromasa Ito, Daisuke Izumi, Kozo Hoshino, Tetsuya Seko, Takashi Tanigawa, Tetsuya Kitamura, Norikazu Yamada, Hitoshi Kakimoto, Kaoru Dohi
Journal: Circulation (2022)

Backgrounds: Although the mortality rates for AMI have declined, the mortality rate for AMI with out-of-hospital cardiac arrest (OHCA) remains high. It has been supposed that CTO (chronic total occlusion) in non-infarct related artery is associated with OHCA patients. However, the detailed angiographic and prognostic comparison between OHCA patients and non-OHCA patients stratified by Killip classification has not been well evaluated. Methods: Among 5662 AMI patients (5420 non-OHCA patients and 242 OHCA patient) who underwent emergency coronary angiography between 2013 and 2020 were enrolled from Mie ACS registry. Difference of culprit lesion and non-infarct related CTO lesion were analyzed between with and without OHCA. They were further stratified using Killip classification. Results: In-hospital mortality for AMI patients with OHCA was 31.4%, significantly higher than the 5.5% for AMI patients with non-OHCA (p&lt;0.001), and mortality rates tended to be increased with increasing Killip class in each group(P&lt;0.001). AMI patients with OHCA also had a significantly higher frequency of culprit artery with LMT and LAD and a higher frequency of CTO lesion in non-infarct related artery compared to the AMI patients with non-OHCA.(See Table) Multivariate analysis revealed that LAD CTO in non-infarct related artery(Odds ratio 2.3) culprit artery of LMT and LAD (Odds ratio 3.2 and 1.6), lower BMI(Odds ratio 0.96), younger age(Odds ratio 0.98) and male gender (Odds ratio 1.7)was significantly associated with OHCA(P&lt;0.05, respectively). However, non-LAD CTO lesion in non-infarct related artery was not associated with OHCA Conclusions: Patients with OHCA had a higher incidence of culprit artery with LMT and LAD, and non-infarct-related LAD CTO lesion, suggesting that extensive myocardial ischemia with LAD lesion was strongly associated with OHCA.
Abstract 264: Socioeconomic Status And Outcomes After In-Hospital Cardiac Arrest
Authors: Nikola Stankovic, Mathias J Holmberg, Asger Granfeldt, Lars W Andersen
Journal: Circulation (2022)

Introduction: We aimed to investigate the association between socioeconomic status and outcomes after in-hospital cardiac arrest in Denmark. Methods: We conducted an observational cohort study based on nationwide registries and prospectively collected data on in-hospital cardiac arrest from 2017 and 2018 in Denmark. Unadjusted and adjusted analyses using regression models were performed to assess the association between socioeconomic status and outcomes after in-hospital cardiac arrest. Outcomes included return of spontaneous circulation (ROSC), survival to 30 days, survival to one year, and the duration of resuscitation among patients without ROSC. Results: A total of 3,223 patients with in-hospital cardiac arrest were included in the study. In the analyses adjusted for patient and cardiac arrest characteristics, patients with high household assets had 1.20 (95%CI: 0.96, 1.51) times the odds of ROSC, 1.49 (95%CI: 1.14, 1.96) times the odds of survival to 30 days, 1.40 (95%CI: 1.04, 1.90) times the odds of survival to one year, and 2.8 (95%CI: 0.9, 4.7) minutes longer duration of resuscitation compared to patients with low household assets. Similar albeit attenuated associations were observed for education. While high household income was associated with better outcomes in the unadjusted analyses, these associations largely disappeared in the adjusted analyses. Conclusions: In this study of patients with in-hospital cardiac arrest, we found that high household assets were associated with a higher odds of survival and a longer duration of resuscitation among patients without ROSC compared to low household assets. However, the results varied pertinent to SES measure, outcome of interest, and across adjusted analyses.